Policy Updates

Moody’s: Tough Year Ahead for Non-Profit Hospitals

Non-profit hospitals may not fare well financially in 2019, suggests Moody’s Investor Services, the financial services and rating company. The challenge, according to Moody’s: Revenue growth will be constrained as the sector continues to face numerous challenges, including low patient volume growth and higher bad debt as co-pays and deductibles rise. In addition, Expense growth is anticipated to slow through cost-cutting measures and lower increases in drug prices. However, expenses will still outpace revenues due to the ongoing need for temporary nurses, continued recruitment of employed physicians, wage increases associated with lower unemployment, innovative specialty drugs, and increased use of [...]

iqtsupport2018-12-07T06:00:27-05:00December 7, 2018|hospitals|

CMS Introduces New Waivers

The Centers for Medicare & Medicaid Services has introduced four new “state relief and empowerment waivers” that are widely viewed as new vehicles for states to circumvent Affordable Care Act requirements to implement their own new approaches to health care. Through “account-based subsidies” waivers, states may direct public subsidies into defined-contribution, consumer-directed accounts that individuals use to pay for health insurance premiums or other health care expenses. “State-specific premium assistance” waivers enable states to create their own subsidy programs. “Adjusted plan options” authorizes states to provide financial assistance for different types of health insurance plans, including short-term and other health [...]

iqtsupport2018-12-03T06:00:13-05:00December 3, 2018|Affordable Care Act, health care reform|

Number of Uninsured Children Rises

For the first time since 2008, the number of uninsured children in the U.S. increased in 2017, according to a new report from the Georgetown University Health Policy Institute. While the total increase in the number of uninsured children is small – just 276,000 – 2017 marked the first time in nearly a decade that the number of uninsured children has risen. For the year, 3.9 million were uninsured, up from 3.6 million in 2016. Passage of the Affordable Care Act and extension of the Children’s Health Insurance Program (CHIP) have contributed to declines in the number of uninsured children. [...]

iqtsupport2018-11-30T06:00:36-05:00November 30, 2018|Uncategorized|

OIG Cites “Vulnerabilities” in Medicare Wage Index System

The Office of the Inspector General of the U.S. Department of Health and Human Services has “…observed significant vulnerabilities in the [Medicare area] wage index system…” As a result of these vulnerabilities, Medicare has overpaid 272 hospitals by more than $140 million over the past 13 years. The vulnerabilities the OIG identified that contributed to these overpayments are: absent misrepresentation or falsification, CMS lacks the authority to penalize hospitals that submit inaccurate or incomplete wage data; Medicare Administrative Contractors’ limited reviews do not always identify inaccurate wage data; the rural floor decreases wage index accuracy; and hold-harmless provisions in federal [...]

iqtsupport2018-11-29T06:00:57-05:00November 29, 2018|Medicare regulations|

Administration Seeks Industry Guidance on Rollback of Anti-Kickback Laws

Characterizing its objective as a “regulatory sprint to coordinated care,” the Department of Health and Human Services’ Office of the Inspector General this summer asked stakeholders for their input on how it might ease federal anti-kickback laws in ways that promote better coordination of care and cooperation between different types of caregivers while not encouraging fraud that costs consumers and taxpayers. At the heart of this effort are laws that limit the ability of doctors and hospitals to work together. Hospitals, for example, currently have limited tools with which to influence the behavior of doctors serving Medicare and Medicaid patients [...]

iqtsupport2018-11-27T11:00:02-05:00November 27, 2018|Medicare|

CMS to Congress: You’re the Impediment to Greater Use of Telehealth

The primary obstacle to Medicare making greater use of telehealth is current laws, the Centers for Medicare & Medicaid Services has told Congress in a new report. The report, mandated by the 21st Century Cures Act, outlines the extent of telehealth utilization today, describes its benefits, and suggests potential new and expanded uses for telehelath, but it also notes that Current restrictions on eligible telehealth originating sites appear to be the greatest barrier to preventing the expansion of Medicare telehealth services. The two most significant Medicare restrictions are: 1) requiring the originating site to be located in certain types of [...]

iqtsupport2018-11-20T06:00:23-05:00November 20, 2018|Medicare, Telehealth|

Medicare Advantage to Address Social Determinants of Health

Beginning next year, the Centers for Medicare & Medicaid Services will authorize Medicare Advantage plans to pay for some health-related but non-medical benefits for their members – benefits that will help address social determinants of health that affect the health status of many Medicare beneficiaries. As explained by Health and Human Services Secretary Alex Azar at a recent event in Salt Lake City, These interventions can keep seniors out of the hospital, which we are increasingly realizing is not just a cost saver but actually an important way to protect their health, too. If seniors do end up going to [...]

iqtsupport2018-11-19T06:00:47-05:00November 19, 2018|Medicare|

Medicaid to Help Pay for Food, Heat, Rent?

Maybe. At least that is what Department of Health and Human Services Secretary Alex Azar hinted during a recent symposium held in Salt Lake City. During the event, Azar said that HHS’s Center for Medicare and Medicaid Innovation seeks …solutions for the whole person, including addressing housing, nutrition, and other social needs. Azar hinted at future CMMI action, saying that What if we gave organizations more flexibility so they could pay a beneficiary's rent if they were in unstable housing, or make sure that a diabetic had access to, and could afford, nutritious food? If that sounds like an exciting idea [...]

iqtsupport2018-11-16T06:00:28-05:00November 16, 2018|Center for Medicare and Medicaid Innovation, Medicaid, Medicaid and housing for the disabled|

CMS Proposes New Medicaid Managed Care Regulation

Just two years after a major overhaul of Medicaid managed care regulations, the Centers for Medicare & Medicaid Services is again proposing changes in how the federal government regulates the delivery of managed care services to Medicaid beneficiaries. Under the newly proposed regulation, states would: be free to implement more changes in their managed care programs without seeking federal permission; have slightly more flexibility in how supplemental payments are made to hospitals through managed care plans and implement some such changes without federal approval; be permitted to redefine what constitutes an adequate provider network for managed care plans; and not [...]

iqtsupport2018-11-14T06:00:22-05:00November 14, 2018|Centers for Medicare & Medicaid Services, hospitals, Medicaid, Medicaid managed care, Medicaid regulations|

The Changing of the Congressional Health Care Guard

Last week’s elections will bring to office in January a new majority party in the House and changes in the Senate as well. Changes in leadership are coming in all of the House committees with jurisdiction over health care matters: Energy and Commerce, Ways and Means, Appropriations, and Oversight and Government Reform. New leadership may be coming to the Senate Finance Committee as well. Kaiser Health News has published a look at the relevant committees, their likely new leaders, and the priorities of those new leaders. Find that report here.

iqtsupport2018-11-13T06:00:56-05:00November 13, 2018|Uncategorized|